Preliminary tests of dosimetric quality and projected therapeutic outcomes of multi-phase 4D radiotherapy with proton and carbon ion beams

Lis, Michelle; Newhauser, Wayne D.; Donetti, M.; Wolf, Moritz; Steinsberger, Timo; Paz, Athena; Graeff, Christian

doi:10.1088/1361-6560/ac36e7

Cited by 4 publications

(1 citation statement)

References 48 publications

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“…In order to perform the treatment correctly and quickly, high-performance instruments that measure the characteristics of the particle beams and guide the systems that deliver the dose to the tumour are needed. The CNAO Foundation is developing, in collaboration with GSI and INFN, a new generation of active beam delivery monitoring system, the so-called Dose Delivery System 4.0 (DDS4) [51].…”

Section: Improving Delivery Technologymentioning

confidence: 99%

Hadron Therapy Achievements and Challenges: The CNAO Experience

Rossi

2022

Physics

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Protons and carbon ions (hadrons) have useful properties for the treatments of patients affected by oncological pathologies. They are more precise than conventional X-rays and possess radiobiological characteristics suited for treating radio-resistant or inoperable tumours. This paper gives an overview of the status of hadron therapy around the world. It focusses on the Italian National Centre for Oncological Hadron therapy (CNAO), introducing operation procedures, system performance, expansion projects, methodologies and modelling to build individualized treatments. There is growing evidence that supports safety and effectiveness of hadron therapy for a variety of clinical situations. However, there is still a lack of high-level evidence directly comparing hadron therapy with modern conventional radiotherapy techniques. The results give an overview of pre-clinical and clinical research studies and of the treatments of 3700 patients performed at CNAO. The success and development of hadron therapy is strongly associated with the creation of networks among hadron therapy facilities, clinics, universities and research institutions. These networks guarantee the growth of cultural knowledge on hadron therapy, favour the efficient recruitment of patients and present available competences for R&D (Research and Development) programmes.

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Section: Improving Delivery Technologymentioning

confidence: 99%

Hadron Therapy Achievements and Challenges: The CNAO Experience

Rossi

2022

Physics

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Exploring energy selection methods for robust biologically optimized carbon ion arc for head&neck cancer patients

Volz,

Sheng,

Kong

et al. 2024

Health Technol.

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Background Due to the advantageous depth dose profile of carbon ion beams, carbon ion therapy is commonly applied in the form of intensity modulated particle therapy (IMPT) with few treatment fields. Carbon ion arc therapy (C-Arc) has recently been proposed to improve dose conformity and increase the dose-averaged linear energy transfer (LETd) inside the target to levels relevant for overcoming tumor radioresistance. In this work, we investigate different energy selection approaches for C-Arc, including a novel greedy energy layer refinement strategy. Methods Robust biologically optimized C-Arc plans were generated for six head &neck cancer patient previously treated at the Shanghai Proton and Heavy Ion Center (SPHIC). Different heuristic approaches for mono- and dual-energy C-Arc were implemented, and compared to carbon IMPT pans. A novel greedy energy layer refinement was developed, acting directly on the dose influence matrix, rather than on an iterative plan optimization. A key challenge in C-Arc with few energy layers per angle is the sharpness of the carbon ion Bragg peak, which is challenging for plan robustness. To improve robustness and plan quality, we propose the use of a 6 mm ripple filter instead of the typical 3 mm ripple filter used for carbon IMPT. Results Most mono-energetic C-Arc plans were able to meet the established clinical goals, but some of the heuristic energy selection schemes were not universally applicable with low plan quality in some patients. The developed energy layer refinement strategy delivered high quality plans even for complex cases. Mono-energetic C-Arc plans presented an average increase between 10% and 33% in the maximum LETd in the target, with similar or up to 19% improved average target LETd$$_{50\%}$$ 50 % compared to the IMPT carbon ion plans. C-Arc plans with 2 energies per treatment angle, for the employed energy selection heuristic, improved dosimetric quality compared to mono-energetic C-Arc plans, but did not provide the same natural improvement in LETd compared to IMPT. Conclusions For small, centrally located targets C-Arc demonstrates the greatest potential, but feasible plans could also be achieved for more complex cases in this work. Further development is necessary for improving C-Arc delivery efficiency and plan quality toward possible clinical application.

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